Expert Recommends Significant Change to Bone Marrow Transplantation

One of the world's leading bone marrow transplant experts is recommending a significant change to current transplant practice.

For patients who need marrow or adult stem cells from an unrelated donor to treat hematological malignancies, bone marrow, not circulating, peripheral blood, which is the current norm, should be the source for unrelated donor adult stem cells for most patients who require a transplant.

Scientists at the Fred Hutchinson Cancer Research Center (Seattle, WA, USA) compared survival rates and side effects of treating patients with hematopoietic adult stem cells derived from bone marrow versus circulating peripheral blood. The study enrolled 551 patients at 48 centers between March 2004 and September 2009. Patients were randomly assigned in a 1:1 ratio to peripheral-blood stem cells or bone marrow transplantation. The investigators found no difference in two-year survival, faster engraftment and less graft failure, but a significant increase in chronic graft-versus-host disease (GVHD) when patients were transplanted with stem cells derived from peripheral blood.

The study found a higher incidence of chronic GVHD, 53 % when peripheral blood was the source of stem cells for transplant, versus 41%, when bone marrow is the source. The potential impact if such a practice change were widely implemented is significant. Currently, about 75% of unrelated donor transplants are done using stem cells that are collected from the peripheral blood of donors. About 70% of all patients who undergo a life-saving transplant to treat blood cancers such as leukemia require an unrelated donor. The collection of adult stem cells from bone marrow is a more invasive process than collecting them from the bloodstream.

Frederick Appelbaum, MD, director of the Clinical Research Division at Fred Hutchinson Cancer Research Center, said, "For the majority of unrelated transplants following a standard high-dose preparative regimen, bone marrow should be used since survival is equivalent with the two sources but the incidence of chronic graft-versus-host disease, which can be a debilitating complication, is significantly less with marrow." The study was published on October 18, 2012, edition of in the New England Journal of Medical (NEJM).

Related Links:
Fred Hutchinson Cancer Research Center